Private Health Insurance: Progress and Challenges in Implementing 1996 Federal Standards : Report to the Chairman, Committee on Health, Education, Labor, and Pensions, U.S. Senate

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Page 30 - We also interviewed individuals at national organizations, including the National Association of Insurance Commissioners, the Health Insurance Association of America, the BlueCross BlueShield Association, and the Council for Affordable Health Insurance.
Page 34 - ... restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours...
Page 32 - ... exceptions. Exceptions include cases of fraud, failure to pay premiums, enrollee movement out of a plan service area, the cessation of membership in an association's health plan, and the withdrawal of an issuer from the market. Limitations on Preexisting Condition Exclusion Period Group plan issuers may deny, exclude, or limit an enrollee's benefits arising from a preexisting condition for no more than 12 months following the effective date of coverage. A preexisting condition is defined as a...
Page 34 - ... for reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance: and prostheses and treatment of physical complications aft all stages of the mastectomy, including lymphedemas.
Page 33 - ... of COBRA coverage rights, new disclosure requirements for Employee Retirement Income Security Act plans, and new requirements for uniform enrollee and claims information, to be phased in through 1999.
Page 32 - ... time against its preexisting condition exclusion period. The certificates must also document any period during which the enrollee applied for coverage but was waiting for coverage to take effect — the waiting period — and must include information on an enrollee's dependents covered under the plan. Guaranteed Access/Availability In the small group market, carriers must make all plans available and issue coverage to any small employer that applies, regardless of the group's claims history or...
Page 41 - DEPARTMENT OF HEALTH & HUMAN SERVICES Health Care Financing Administration Center for Medicaid and State Operations...
Page 35 - January' 11,1 999, for a summary of resources spent by the Department of Labor's Pension and Welfare Benefits Administration (PWBA) on activities related to implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In order to best respond to your request, we have enclosed charts organized by fiscal year that delineate FTE received as part of the agency's FY1998 and FY 1999 appropriation as well as the dollar amounts spent in FY 1 997, FY 1 998, and estimated to be...
Page 33 - Individuals who do not enroll in a group plan during their initial enrollment opportunity may be eligible for a special enrollment period later if they originally declined to enroll because they had other coverage, such as coverage under COBRA, or were covered as a dependent under a spouse's coverage and later lost that coverage.
Page 33 - ... preexisting condition exclusion period. Prior coverage must have been consecutive, with no breaks of more than 63 days to be creditable. For example, an individual who was covered for 6 months who changes employers may be eligible to have the subsequent employer plan's 12-month waiting period for preexisting conditions reduced by 6 months. Time spent in a prior health plan's waiting period cannot count as part of a break in coverage. Special Enrollment Periods Individuals who do not enroll...

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